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Low sensitivity, positive predictive value: low PAPP-A tied to poor pregnancy outcomes.

NEW ORLEANS -- A low first-trimester serum level of pregnancy-associated plasma protein A is an independent risk factor for several adverse obstetric outcomes, Dr. Lorraine Dugoff reported at the annual meeting of the Society for Maternal-Fetal Medicine.

Although many of the associations are highly statistically significant, the sensitivity and positive predictive values for the individual outcomes are relatively low, said Dr. Dugoff, a coinvestigator for the First and Second Trimester Evaluation of Risk for Aneuploidy (FASTER) trial.

The FASTER trial is a National Institutes of Health-sponsored study conducted at 15 major medical centers across the United States to compare first- and second-trimester aneuploidy screening. More than 38,000 women were screened using nuchal translucency measurement and serum markers in the first trimester, and using quad screening in the second trimester.

Dr. Dugoff's subanalysis of the FASTER trial examined the relationship between poor outcomes, high and low serum levels of pregnancy-associated plasma protein A (PAPP-A), and high and low serum levels of free [beta]-HCG in the first trimester. Patients with known fetal anomalies were excluded from this analysis, said Dr. Dugoff of the University of Colorado, Denver.

The strongest association occurred between PAPP-A at or below the fifth percentile and intrauterine growth restriction. Women with a low PAPP-A level had an increased risk of IUGR (odds ratio 3.22). Nine other adverse obstetric outcomes were also associated with low PAPP-A levels. (See chart.)

The only adverse obstetric outcome associated with low free [beta]-HCG (at or below fifth percentile) was increased risk of fetal loss at or beyond 24 weeks' gestation (odds ratio 2.56).

High levels of free [beta]-HCG and PAPP-A (95th percentile or higher) were not associated with an increased risk in any of the outcomes.
Outcomes in Women With PAPP-A Levels at or Below Fifth Percentile In
FASTER Trial

 Odds Ratio
Intrauterine growth restriction 3.22
Birth weight at or below fifth percentile 2.81
Fetal loss before 24 weeks 2.50
Fetal or neonatal loss 2.15
Preterm birth at or before 32 weeks 2.10
Preterm birth at or before 37 weeks 1.87
Placental abruption 1.80
Premature preterm rupture of membranes 1.54
Preeclampsia 1.54
Gestational hypertension 1.47

Source: Dr. Lorraine Dugoff


BY MICHELE G. SULLIVAN

Mid-Atlantic Bureau
COPYRIGHT 2004 International Medical News Group
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2004 Gale, Cengage Learning. All rights reserved.

 
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Title Annotation:Obstetrics
Author:Sullivan, Michele G.
Publication:OB GYN News
Date:Apr 1, 2004
Words:377
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